August 14, 2009

Here is my rough, very paraphrased, partial transcript (not perfect) and a couple of comments.

2:11 Central Time: Obama points out that people with health insurance are not really secure -- they can be dropped.

2:18: Companies slashing payroll to pay for health insurance.

2:19: People across the nation gathering and having difficult discussions about Health Care in a civil way -- that reflects America.

2:21: Reform will stop the practice of insurers dropping sick policy holders on pretext of application mistakes. One (limited) study found "20,000" dropped this way. The woman dropped during breast cancer for not including acne on her original application for insurance.

2:22: Insurers to be prohibited from denying coverage for preexisting conditions, and also not allowed to place caps (limits) on annual or lifetime costs. Limits also on out-of-pocket expenses.Finally, insurers to be required to cover preventive routine checkups -- mammograms, etc.

2:24: I don't want gov. bureaucrats meddling in your healthcare, but I also don't want insurance company bureaucrats meddling in your healthcare (applause).

2:26: Everytime we are in sight of healthcare reform, special interests try to "scare the heck" out of people. "...what is truly scary...is if we do nothing." 14,000 lose coverage everyday. The deficit would continue to grow. In about 8 years Medicare goes into the red, and consider we already are limited by deficits right now.

"Change is never easy. It never starts in Washington. It starts with you."

Questions:

2:30 Can you pick and choose from foreign health care systems that work and use those ideas here?A: Americans spend $5,000-$6,000 more per year than people in any other nation. You don't notice it when your employer pays most of your premium, but we have smaller pay increases as a result. ... Countries like Netherlands -- private in all respects except Government is the insurer... What we've said is, let's find a uniquely American system, because a majority gets health insurance on the job. Changing everything is too disruptive. ... We would give someone like you (the woman asking the question) a tax credit to help you buy insurance.... We would set up an exchange (to buy insurance). We would reform insurance practices.

Obama has laid out much of his view of reform in a nutshell here.

2:35 Medicare changes?A: ...What we've proposed is not to change benefits nor to rationcare.... What we've proposed is to eliminate some of the practices that are not making people healthy. Such as Medicare subsidies to insurers [that don't subsidize care, but are instead only extra profits for the insurers at tax payer expense.]If you take your car in to be fixed and it breaks a week later what if the mechanic said ok, let's just start over [and charge you again.] That wouldn't make sense. We want to give hospitals incentives to change this practice [similar to the auto repair example -- give hospitals incentives (money) to reduce re-admissions].

Highlights only now, paraphrased --

"We don't have a heath care system. We have a disease care system."Emphasizes preventive care, such as preventing diabetes from leading to an expensive foot amputation.

Q:How can you pay for all of this?A: 2/3 from efficiencies, eliminating waste. Other 1/3:....taxes...Obama's proposal: limit high-income tax deductions to the same rate as middle-income tax deduction rates: 28%.

"We've got to get over the idea that we can have something for nothing."

The previous medicare drug-cost (prescription) reform: they (Bush and Congress) did not pay for the costs in the legislation... That's part of our deficit now.

...

Here's what the Public Option actually is: Just like a big insurer, but not-for-profit. What opponents argue is you can't have a level playing field -- it would drive private insurers out of the market. That is a legitimate concern,...if the public option is being subsidized.

Q: Will a Public Option be effectively subsidized because it underpays, like Medicare, so that private insurers paying higher rates to doctors effectively subsidize Medicare?A: Let's change the way we pay for care -- results instead of procedures. But...yes, if doctors only collect 80 cents on the dollar (from Medicare) then yes, private policies make up the difference. Also...free Emergency Room care is paid for by all of us paying taxes and insurance premiums. We are *already* paying for this subsidized care, but don't know it.

[Obama seems to be implying that since Medicare pays for a lot of waste (ineffective, redundant hospital procedures) in addition to effective care, and that this difference, the waste, is the source of the answer to how Medicare *is not* subsidized. That is, the total payments from medicare include the extra payments for useless care that does nothing, and thus balances against the underpayment vs. private insurers. I think that's what he meant.]

A: I believe private insurers do have a place in the health care system. I want to see practices that are very tough on people, that those practices change. Some of these changes are very hard to achieve unless everyone is covered (mandated). This stops cherry picking. Insurers are willing to accept this because the added new customers will help balance the costs of more complete insurance (better practices). The only way to change practices that hurt people is if everyone is covered.